In-network
Blue Medicare Essential Plus (HMO-POS)
Emergency transport
Ambulance
Emergency services
Emergency room
$130 copay
Waived if admitted within 48 hours
Medical maximum
Maximum out-of-pocket
Skilled care at home
Home health
Monthly cost
Premium & giveback
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Primary care physician
In: $0 copay · Out: Not separately reported
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Specialist
In: $30 copay · Out: Not separately reported
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Preventive care
In: $0 copay · Out: Not separately reported
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Diagnostic procedures & tests
In: $0–$25 copay · Out: Not separately reported
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Laboratory services
In: $0–$5 copay · Out: Not separately reported
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X-rays & standard imaging
In: $0–$300 copay + 20% coinsurance · Out: Not separately reported
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MRI, CT & PET imaging
In: $0–$60 copay + 20% coinsurance · Out: Not separately reported
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: $130 copay · Out: Not separately reported
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Ground ambulance
In: $300 copay · Out: Not separately reported
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Air ambulance
In: $300 copay · Out: Not separately reported
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Outpatient hospital
In: $0–$400 copay · Out: Not separately reported
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Outpatient surgery / ASC
In: $0–$350 copay · Out: Not separately reported
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Home health
In: $0 copay · Out: Not separately reported
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: $0 copay · Out: Not separately reported
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Occupational therapy
In: $20 copay · Out: Not separately reported
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Physical & speech therapy
In: $20 copay · Out: Not separately reported
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Mental health services
In: $60 copay · Out: Not separately reported
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Substance use treatment
In: $60 copay · Out: Not separately reported
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Podiatry
In: $30 copay · Out: Not separately reported
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Chiropractic
In: $15 copay · Out: Not separately reported
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Dental
In: $30 copay · Out: Not separately reported
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Vision
In: $0 copay · Out: Not separately reported
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Hearing
In: $0 copay · Out: Not separately reported
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Transportation
Not reported in this CMS export
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Fitness & wellness
In: $0 copay · Out: Not separately reported
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Over-the-counter allowance
In: $0 copay · Out: Not separately reported
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Meals
In: $0 copay · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
Specialist
Preventive care
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
Laboratory services
X-rays & standard imaging
MRI, CT & PET imaging
Urgent & hospital care6 benefits
Urgent care
Emergency room
Ground ambulance
Air ambulance
Outpatient hospital
Outpatient surgery / ASC
Recovery & therapy5 benefits
Home health
Skilled nursing facility
Cardiac & pulmonary rehabilitation
Occupational therapy
Physical & speech therapy
Behavioral health2 benefits
Mental health services
Substance use treatment
Specialty care2 benefits
Podiatry
Chiropractic
Supplemental benefits7 benefits
Dental
Verify in plan documentsVision
Hearing
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
Over-the-counter allowance
Meals
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
Medical deductibles
Network & referrals
HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported
Prescription drugs6 tiers
Part D deductible
Not reported
Drug tier 1
$15 retail copay · 30-day supply
Drug tier 2
$20 retail copay · 30-day supply
Drug tier 3
25% retail coinsurance · 30-day supply
Drug tier 4
25% retail coinsurance · 30-day supply
Drug tier 5
25% retail coinsurance · 30-day supply
Drug tier 6
$3 retail copay · 30-day supply
Using this plan
Understand H3449-023-004
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Blue Medicare Essential Plus (HMO-POS) is a 2026 HMOPOS offered by Blue Cross and Blue Shield of North Carolina in Essential Plus Region 4. Referrals are required for some services. Its listed inpatient copay stages total $2,400 across 6 charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- $0 copay
- Specialist
- $30 copay
- Laboratory services
- $0–$5 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- $0–$25 copay
- MRI, CT & PET imaging
- $0–$60 copay + 20% coinsurance
- Outpatient hospital
- $0–$400 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $130 copay
- Listed inpatient stages
- $2,400 total
6 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Essential Plus Region 4 (NC)
- Plan type
- HMOPOS
- Contract / plan
- H3449-023
- Coverage year
- 2026
Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Plan-specific answers
Frequently asked questions
Where is H3449-023-004 available?
Blue Medicare Essential Plus (HMO-POS) is listed for Essential Plus Region 4 (NC). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H3449-023-004?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $6,750. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H3449-023-004?
The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H3449-023-004?
The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.
Does H3449-023-004 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H3449-023-004 fits
- Full CMS plan ID
H3449-023-004- Contract
H3449- Base plan code
H3449-023- Segment
004- Carrier
- Blue Cross and Blue Shield of North Carolina
- Plan type
- HMOPOS
- Service area
- Essential Plus Region 4 (NC)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Anson, NC
- Cabarrus, NC
- Camden, NC
- Carteret, NC
- Cherokee, NC
- Clay, NC
- Craven, NC
- Currituck, NC
- Dare, NC
- Franklin, NC
- Granville, NC
- Montgomery, NC
7 additional service-area entries are retained in the data record.
About this code
What H3449-023-004 identifies
H3449-023-004 is a Contract Year 2026 Medicare plan segment code. Searches written as H3449-023, H3449 023, or the compact full CMS ID H3449023004 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.